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17 CAMBRIDGE ST - BUILDING INSPECTION (2) 9btUST-9E fIL£�: APPROVED BY T44E MPECTDR PRICIR TP A.PERMIT .B,EING GRANTED CITY OF SALEM No. 1 l Date 'GYrnN%�y Is Property Located In Location of /7 the Historic District? Yes_No_ Buildings 2 ST Is Property Located in / the Conservation Area? Yes No IG BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roo f Install Sidin , Construct Dec} , ed, Pool, Repair/Repla , Other: C frvh�llc�S I T— PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: //- rr Owner's Name �' 4Tweci W 14I7-�ft c k Address use CA Ai 84)Ae- S ( ) Architect's Name All 4 Address & Phone / ) Mechanics Name LjLU-tt91-1 L4C4 Address & Phone 57 46S904-L9` f9 U a-- bq/�M (9W) 7 2 `- V 6 2 o What is the purpose of building? Sr Lvs "(_, Fa wt 'LY Material of building? q j D 6A If a dwelling, for how many families? Will building conform to law? I C Asbestos? /1 2 Estimated cost /r� ✓J 00 City License k N Pk state License # O 3 c U-Lome Improvement v Lie. /I Jl r1 �""�— Ina- Signature of Applib&nt SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE 74 iZe- h W IQ nce_ 0-9r d# tol tAts-r- COMM. MAIL PERMIT TO: -5- /4DSz de LT 4 J Q-- 640U�Q 4S pf.7,2 •t No. Zee CD APPLICATION FOR PERMIT TO LOCATION ` PERMIT GRANTED AP VFD INSPECTO OF BUILDINGS C01nM.0/1Wt:aLLI1. oh ///a6dacYlic6CH6 aJ• w ict-yy� n /— Jepa,lma nl of 9stdsul,J�rC A:nit /7 600 Ul�aLllon-31,441 Jame$J.carnooell &i. , /!/aaaachttaalls 02111 comoussrona Workers' Compensation Insurance Affidavit — a tr�..r,a.inees with-a principal place of business at: �f��SFd(c 4oc— f catrss.awtaq do hereby certify under the pains and penalties of perjury, that: () 1 am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number //�1 am a sole proprietor and have no one working for me in any capacity. () 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number O I am a homeowner performing all the work myself. I understand wt a coon of this stator t wil be iorwaroto to the Office of Imssfgauens of the DIA for coverage verWation ano Chat faiwe to Secure eoverare u neaireo,wer Section 25A of HGL 152 can Wo to the irmos,tion of criminal otnntus corsutint of a Erse of w cod 1.500.00 xWor one years,6,twnmrnt v rrsa as dvi Demises in the loan of a STOP WORK ORD ano a 6se of S 100.00 a Sur against mt. Signed this o day of Licensee/Fermittee Building Department Licensing Board Selectmen Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 �o OF SALEM. MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT .3° ® 120 WASHINGTON STREET, 3RD FLOOR 1, SALEM, MA01970 .' TEL. (978)745-9595 EXT. 380 ynrta FAx (878) 7 40-9846 STANLEY J. USOVICZ, JR. - MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition of Building Permit# all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid-waste disposal facility,as defined by MGL c III, S150k The debris will be disposed of at: &i o c &j t SA+�� Sc�< c �C Location of Facility 4Siture ermit Applicant Dab FULLY complete the following information: (PLEASE PRINT CLEARLY) Name of Permit Applicant Firm Name,if any ,�7 4uekL'T- VC- 051/dj! S &719 O(F Address, City& State The above statute requires that debris from the demolition,renovation,rehab or other alteration of building or structure be disposed in a properly-licensed solid-waste disposal facility as defined by MGL cIII, S 150A, and the building permits Or licenses are to indicate the location of the facility. 4 Salem Historical Commission ONE SALEM GREEN,SALEM, MASSACHUSETTS 01970 (978)745-9595 EXT.311 FAX(978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving Reconstruction ❑ Alteration Demolition ❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire Address of Property- 17 Cambridge Street Name of Record Owner: Penelope Neal & Matthew Whitlock Description of Work Proposed: Repair two chimneys of main portion of house to replicate existing. Replace existing asphalt roof to replicate existing charcoal black 3-tab roof. No changes in color, material, design or outward appearance. Reinstall flat, glazed, operable, low profile skylight in existing size and location. Non-applicable due to being in kind replacement/maintenance. Dated: July 3, 2003 SALEM HISTORICAL COMMISSION By. G� The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. Salem Historical Commission ONE SALEM GREEN,SALEM, MASSACHUSETTS 01970 (978)745-9595 EXT.311 FAX(978)740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction ❑ Alteration Demolition ❑ Painting Signage i Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (M.G.L. Ch. 40C)and the Salem Historic Districts Ordinance. District: McIntire Address of Property: 17 Cambridge Street Name of Record Owner: Penelope Neal &Matthew Whitlock Description of Work Proposed: Demolition of chimney on rear ell and roof over opening to match existing. Installation of bluestone cap with brick legs on two chimneys of main part of house. Option to install pop-up flue covers. Dated: July 3, 2003 SALEM HISTORICAL CCOMMISSIONN The homeowner has the option not to commence the work(unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work.